Page 52 - September 2021 Issue.indd

staying with the same plan next year. Tier 4: Non-preferred brand name and

After reading the notices there is the real some non-preferred, highest cost generic
possibility that you will need to switch to drugs.
Spot needs, and purse, come the new year. Tier 5: Highest cost drugs includes most
Senior a diff erent plan which better suits your
specialty medicines which are generally
Drug costs and deductibles change
drugs plus those that can require special
annually. Remember that the deductible disease specific and high technology
Senior Moments is your out-of-pocket cost before the dispensing conditions.
by Mary Moran plan starts to pay. For most plans in If a beneficiary is on a specialty drug
410-829-2535/ 410-490-3078 2021 the deductible has been $435. Be that is not on the EOB formulary for
forewarned that this amount continues
to climb every year. 2022, and it is not listed on any tier in
Open Enrollment is just around the your EOB, it will not be covered by the
corner, folks! It begins October 15th and Drug tiers are a way for insurance plan next year. This means you will pay

ends December 7. Remember that your companies to establish medicine full price for the drug. One may make
Caroline County SHIP, Mary Moran, costs. The higher the tier, the higher an appeal and request that the plan add
is here to assist you with drug plan the plan’s cost of medicines, thereby it to their formulary, but there are no
evaluations and plan changes during establishing higher out of pocket costs guarantees that it will be accepted or
this enrollment period! For those who for beneficiaries. Every year the drug become much more affordable. You,
want to prepare for OE, the following companies can, and do, change the tier or your prescriber, can go directly to

is a guide for beneficiaries to evaluate (cost level) of medicines. Each tier, or the drug manufacturer to apply for
any changes to one’s current Medicare level of coverage, has a defined out of participation in their Patient Assistance

prescription drug plan as of January pocket cost. The annual deductible Programs (PAP) and get the medication
1, 2022. is applied to tier 3, 4, & 5 drugs. A at a reduced cost if you meet program
medication that was tier 2 this year may criteria.
Medicare Part “D” prescription
drug plans will be sending out your change next year to a 3, or even a 4, and Note that if one participates in a program,
Annual Notice of Change (ANOC) in kick in the deductible in your current such as SPDAP or EXTRA Help, which
mid-September. It is typically mailed plan. Fortunately, Tier 1 copays can be allows beneficiaries to change plans
with the Evidence of Coverage notice as little as $0 for generics and Tier 2’s outside of open enrollment, the out of
(EOB) which outlines a more detailed are cheap! pocket amount they have paid toward
list of the plan’s costs and benefits Tier 1: Preferred, low-cost generic drugs. the deductible follows that benefi ciary
for next year. If you are in the habit to the new plan when a change is made.
of not reading, or just tossing, the Tier 2: Non- preferred, low-cost generic It does not start over!
monthly statements you get from your drugs.
prescription drug plan, do not toss this Tier 3: Preferred Brand name drugs and Finally, check to make sure your
one! You need to read both notices to some higher cost generic drugs. May Pharmacy of choice is still in network
look for any upcoming changes for 2022. have some lower cost generic or brand- and verify its preferred (vs. standard)
They will help you decide if you will be named alternatives in level 1 or 2. status. That status distinction can

drastically aff ect costs! If you have not
TURNING 65? received your ANOC and EOB by the
end of September, contact the plan and
request it, so you can be ready for Open
Confused about all the Medicare Terms & Options?
Enrollment. Sometimes the formularies
Let Me Help You! issued are incomplete, so don’t hesitate
to contact the plan directly for specifi c
2022 coverage information. t has been
Anthony Insurance Services this SHIP’s experience that plans don’t
have solid pricing established until a
Ann M. Anthony week or two after Open Enrollment
starts! Therefore, if you call your current

plan to check on specific coverages
Specializing in Medicare Supplemental Plans, before October 15, be sure to write down
Medicare Advantage Plans, Medicare Part-D Plans, the name of the representative, the date,
and all important information from the
Dental and Vision, Long Term Care, and Life Insurance
Call Ann Today for an Appointment 410-708-0899 • anthonyins17@gmail.com conversation to protect yourself in case
22850 Fleming Road, Denton, MD 21629 the rep gives you misinformation!

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